#levemir

Brand Name: Levemir

Common Dosage Forms:

Solution for injection: 100 units per mL in 10 mL vials, 3 mL FlexPen

FDA Indications/Dosages:

For the treatment of adult and pediatric patients with type 1 diabetes mellitus or adult patients with type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia: Dosage must be individualized. Patients with type 2 diabetes who have not used insulin before should be started on 0.1 to 0.2 U/kg once daily in the evening or 10 units once or twice daily. If changing from a treatment regimen with an intermediate- or long-acting insulin analog or the dose of any oral antidiabetic drug may need to be adjusted. In patients changing from other basal-bolus treatment, conversion can be made on a unit-to-unit basis. Blood glucose monitoring is recommended for all patients with diabetes mellitus. Insulin detemir should be injected subcutaneously in the thigh, abdomen, or upper arm and injection sites rotated daily.

Monitor: HbA1C, FBG

Pharmacology/Pharmacokinetics: Insulin is the primary hormone responsible for carrying out proper glucose utilization in metabolic processes. In adipose and muscle tissue, insulin activates specific enzymes, promotes the transport of monosaccharides (including glucose) across cell membranes, and facilitates the transformation of intracellular amino acids into proteins. Insulin detemir is a recombinant human insulin analog that is long-acting (up to 24 hours). Insulin detemir differs from human insulin in that the amino acid threonine at position B30 has been omitted, and a C14 fatty acid chain has been attached to the amino acid B29. Insulin detemir produces a prolonged action after injection due to a strong self-association of drug molecules and albumin binding. The mean duration of action of insulin detemir ranges from 5.7 hours at the lowest dose and 23.2 hours at the highest dose (per 24 hours).

Drug Interactions: The following drugs may decrease the hypoglycemic effects of insulin detemir: corticosteroids, danazol, epinephrine and other sympathomimetic agents, oral contraceptives, thiazide diuretics, isoniazid, phenothiazines, somatropin, and thyroid hormones. The following drugs may increase the hypoglycemic effect of insulin detemir: oral antidiabetic drugs, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAO inhibitors, propoxyphene, salicylates, somatostatin analog, and sulfonamides.

Contraindications/Precautions: Insulin dosage is very individualized and small changes in dose, syringe brand or size, or insulin brand may necessitate the need for an adjustment of dose. Hypoglycemic reactions are not uncommon in diabetics and may be caused by excessive insulin dose or when glucose absorption is decreased due to fasting, diarrhea, or vomiting. Hypoglycemia may be differentiated from ketoacidosis not only by lab tests but by its symptoms. Symptoms of hypoglycemia include sudden onset, sweating, headache, dizziness, confusion, shakiness, slurred speech, hunger, and a rapid pulse. Symptoms of ketoacidosis include polydipsia, polyuria, drowsiness, anorexia, breathing difficulty, fruity-smelling breath, and nausea or vomiting. Hypoglycemia may be treated with glucose tablets, orange juice, or hard candy. Insulin detemir is not intended for intravenous administration. The prolonged duration of action of insulin detemir is dependent on subcutaneous administration. Pregnancy Category C.

Adverse Effects: Pain at the injection site is slightly more prevalent with LEVEMIR versus NPH human insulin although it is usually mild and does not result in discontinuation of therapy. Allergic reactions are rare and may include rash, edema, pruritus, bronchospasm, hypotension, or shock. As with any insulin, hypoglycemic reactions may be associated with administration of LEVEMIR.

Patient Consultation:

Follow prescribed diet carefully and continually monitor blood or urine glucose as prescribed.

Consult a physician during any illness.

Do not dilute or mix LEVEMIR with any other insulin or solution.

LEVEMIR should be clear and colorless with no particles visible.

Unopened vials should be stored in the refrigerator (36°F-46°F). Do not freeze. LEVEMIR can be kept at room temperature (<86°F) for 42 days. Opened vials should be discarded after 42 days.

Wear or carry diabetes identification in case of emergencies.

If a dose is missed, take it as soon as possible. If it is closer to the time of your next dose than your missed dose, skip the missed dose and stay on regular dosing schedule.

A grandes rasgos, la insulina es la hormona que va a hacer que el azúcar de nuestra sangre pueda entrar en las células. Las personas con diabetes tipo 1 que carecen de esta “llave” la necesitan y hay que aportarla de manera externa ya que el páncreas, que es el encargado de producirla, no funciona. 

Hay diferentes tipos y cada uno actúa de manera diferente

Como podéis ver en la gráfica, unas actúan más rápido, otras más lento, pero combinadas adedcuadamente realizan su función.

Hace unos años las más utilizadas eran la Humana regular (actrapid, amarrilla) que ura unas 6 horas combinada con la NPH (insulatard, verde) que dura 12 horas. De este modo se está cubierto las 24 horas. VENTAJAS: meno pinchazos ya que incluso se pueden mezclar en la misma jeringuilla. DESVENTAJAS: no puedo calcularla tan precisa para las raciones, he de comer sí o sí en los puntos de mayor pico ya que es fácil que haya un bajón y también los bajones nocturnos. Comidas y horarios más estrictos.

Hace unos años llegaron las nuevas insulinas:

Por una parte están las insulinas ultrarrápidas que duran 4 horas y son perfectas para los picos de después de las comidas. Se pueden calcular las unidades necesarias conforme a lo que vamos a comer y al ejercicio que vamos a hacer. No es necesario que haya tanto contro y actúan de forma más parecida al páncreas. Como desventaja tienen que son más pinchazos y no se pueden mezclar con las lentas que presentaremos a continuación. Son la humalog, apidra y novorapid (lispro, aspart, glulisina).

Después están las lentas o ultralentas que duran 24 horas (mas o menos) actúan como el páncreas en cuanto a que éste libera insulina de forma lenta durante todo el día para mantener los niveles óptimos en lass horas de ayuno. Estas son la Lantus (garglina) que se pincha una vez al día y la levemir (detemir) que se suele pinchar dos veces al día por que no llega a durar las 24 horas.

Estos son los tipos que hay, las más comunes. En el  proximo post os explicaré las zonas de punción y la técnica de inyección correcta.